| Interoperability Standards Platform (ISP)

Level 0

Data Element

Gestational Age

Description

"The estimated gestational age (in weeks, or weeks and fraction of week) of the pregnancy at the time of the health care encounter (in contrast to the gestational age at birth), beginning from the time of fertilization. Needs to be correlated with the date the gestational age was documented. Gestational age (written with both weeks and days) is calculated using the best obstetrical estimated delivery date (EDD) based on the following formula: Gestational Age = (280 - (EDD - Reference Date))/ 7"

Submitted By: Nedra Garrett / Centers for Disease Control and Prevention
Data Element Information
Use Case Description(s)
Use Case Description	The data elements above are based on commonly used terms across the industry. Many of these data elements are captured in maternity EHRs, are defined and endorsed by the American College of Obstetricians and Gynecologists (ACOG)2, and are represented in LOINC with Class=”OB.US/clinical”.
Estimate the breadth of applicability of the use case(s) for this data element	There are a large number of stakeholders, e.g., federal researchers and scientists, federal, state and local public health professionals, university-based researchers, clincians, health system administrators, private and public providers of health insurance, public and private-sector developers of new therapies and technologies.
Link to use case project page	https://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?action=edit&ProjectNumber=1398
Healthcare Aims	Improving patient experience of care (quality and/or satisfaction) Improving the health of populations Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s)	https://www.hl7.org/implement/standards/product_brief.cfm?product_id=494 https://www.hl7.org/implement/standards/product_brief.cfm?product_id=494
Additional Specifications	https://www.hl7.org/implement/standards/product_brief.cfm?product_id=494
Current Use	Extensively used in production environments
Supporting Artifacts	https://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?action=edit&ProjectNumber=1399 CDAR2_IG_PREGNANCY_R1_DSTU_2019JAN.pdf
Extent of exchange	N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)	We are not aware of restrictions.
Restrictions on Use (e.g. licensing, user fees)	We are not aware of restrictions.
Privacy and Security Concerns	Pregnancy-related data, particularly pregnancy outcome, is sensitive and private information. It will be important to safeguard identifying information of individuals using current HIPAA standards.
Estimate of Overall Burden	N/A
Other Implementation Challenges	N/A

ASTP Evaluation Details Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1 Maturity - Current Standards	Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2 Maturity - Current Use	Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3 Maturity - Current Exchange	Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4 Use Case(s) - Breadth of Applicability	Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment	This data element is a specialized use of the Level 2 Observation data elements in the Observations data class.

Comment

Submitted by nedragarrett_CDC on 2024-09-30

CDC comments on Gestational Age

CDC requests this data element be considered for inclusion in USCDI V6. A recent CDC/NACHC postpartum care services project documented the feasibility of collecting the data element in EHRs, and the importance for interoperability standards to support data exchange between health organizations to enhance quality improvement initiatives to improve perinatal outcomes.

Justification: The gestational age (in weeks, or weeks and fraction of week) of the pregnancy at time of pregnancy outcome. This data element is critical to inform obstetrical care and testing and evaluate preterm birth outcomes. Current elements do not capture this key outcome to inform infant health and maternal risk. The use case will be relevant for all maternal health patients and infants, all providers involved in maternal and infant health care, and all consumers of maternal and newborn health data used for research, public health and patient care and quality outcomes. The Centers for Disease Control and Prevention, in partnership with the National Association of Community Health Centers (NACHC), worked to build capacity of Federally Qualified Health Centers to improve the health informatics infrastructure for perinatal care measures and use perinatal care measures to identify and address gaps in postpartum care (https://liebertpub.com/doi/10.1089/jwh.2024.0364). Partner health center-controlled networks (Alliance Chicago, Health Choice Network, OCHIN, and Aliados Health) and nine Community Health Centers, implemented strategies to integrate evidence-based recommendations into the clinic workflow and use data-driven health information technology (HIT) systems to improve data standardization for quality improvement of postpartum care services. The respective EHRs were able electronically capture, access and exchange this data element through adequate testing in staging and development EHR environments. NACHC developed an implementation Guide (Improving Quality in Pregnancy and Postpartum Care) to provide practical strategies to leverage data from electronic clinical data systems for improved maternal health care (NACHC-WHPP-Implementation-Guide-2024_3.pdf). This data element is also captured as active in Logical Observation Identifiers Names and Codes (LOINC®) ontology as 18185-9 Gestational age. It is also captured in ICD-10-CM diagnosis codes as Z3A and captured in the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) as 57036006: Fetal gestational age.

Submitted by BLampkins_CSTE on 2024-09-30

CSTE Comment - v6

CSTE supports inclusion of this data element in USCDI V6. Please see previously submitted CSTE comments for additional recommendations.

Submitted by RUy on 2024-04-16

NACHC retains and supports previous comments

NACHC urges the inclusion of gestational age as it determines the trimester, and the week-appropriate diagnostic testing, evaluations, and overall obstetric management of pregnant patients.

Submitted by nedragarrett_CDC on 2024-04-15

CDC's Comment for draft USCDI v5

CDC supports the inclusion of this data element in USCDI v5 as it is an element that may be necessary for calculation of our digital quality metrics from FHIR data.

Submitted by RUy on 2023-09-21

Reaffirming support for Women's Health data elements

The National Association of Community Health Centers (NACHC) remains steadfast in its commitment to advocating for and prioritizing Women's Health data elements. Recognizing the critical role that these factors play in shaping the clinical outcomes of community health center patients, NACHC continues to emphasize the need for comprehensive, accurate, and interoperable women's health data. By reaffirming our support for these essential elements, we aim to drive informed decision-making, policy development, and targeted interventions that address the root causes of health disparities. This underscores NACHC's belief in the transformative potential of this data in building healthier, more equitable communities.

See attached letter of support containing comments on data elements across USCDI submissions and versions, harmonized with ACOG comments

2023-09-20 NACHC USCDIv5 Letter of Support_14.pdf

Submitted by RUy on 2023-04-14

Gestational Age is a fundamental for the practice of Obstetrics

NACHC would like to support Age of Gestation data element for consideration / inclusion to USCDIv4. Age of Gestation is a fundamental and vital data point that primary care and OBGYN physicians across the world need to do proper H&P, diagnosis and scheduling of prenatal care.